Avatrombopag in the Treatment of Pediatric Immune Thrombocytopenia

Official title

A Prospective, One-arm and Open Clinical Study to Assess Efficacy and Safety of Avatrombopag in the Treatment of Pediatric Primary Immune Thrombocytopenia

Overview

To evaluate the safety and efficacy of avatrombopag in the treatment of pediatric primary immune thrombocytopenia in patients who have been treated with eltrombopag before and switched to avatrobopag because of poor efficacy, excessive platelet fluctuation or intolerance, or patient preference, economic reasons, and other reasons.

Detailed description

Immune thrombocytopenia (ITP) is an organ-specific autoimmune disease, which is characterized by decreased platelet count and skin and mucosal bleeding. ITP is a kind of disease with increased platelet destruction and impaired platelet production caused by autoimmunity. Conventional treatment of adult ITP includes first-line glucocorticoid and immunoglobulin therapy, second line TPO and TPO receptor agonist, splenectomy and other immunosuppressive treatments (such as rituximab, vincristine, azathioprine, etc.).

Eltrombopag is currently the only TPO receptor agonist with indications for pediatric immune thrombocytopenia. However, at present, the treatment response of pediatric ITP is not good, and a considerable number of patients need to switched to other TPO receptor agonist, such as avatrombopag, because of poor efficacy, excessive platelet fluctuation or intolerance, or patient preference, economic reasons, and other reasons.

Therefore, the investigators designed this clinical trial to evaluate the efficacy and safety of avatrombopag in the treatment of pediatric immune thrombocytopenia in patients who who have been treated with eltrombopag before and switched to avatrobopag because of different reasons.

Interventions

• Drug Avatrombopag
  After enrollment, all subjects receive Avatrombopag treatment. The initial dose of Avatrombopag administration was an oral 10 mg (\<30kg) or 20mg (≥30kg) once daily in all participants. ps. For subjects weighing ≥30kg, the dose can be started from 40mg once daily if the platelet count is \< 10×10\^9/L or if there is severe bleeding or risk of bleeding. Complete blood count including platelet count was done once a week. The dose of Avatrombopag was adjusted according to the subject platelet coun

Primary outcome measures

• Overall efficacy response after AVA treatment within 12 weeks [Time frame: 12 weeks]

Secondary outcome measures (12)

• Treatment response-1 [Time frame: 12 weeks]
• Treatment response-2 [Time frame: 12 weeks]
• Time to Response [Time frame: 12 weeks]
• Persistent response [Time frame: 12 weeks]
• Emergency treatment [Time frame: 12 weeks]
• Reduction of concomitant drug [Time frame: 12 weeks]
• Number of participants with clinically significant bleeding as assessed using the world health organization (WHO) bleeding scale. [Time frame: 12 weeks]
• Number of participants with clinically significant bleeding as assessed using the bleeding scale for pediatric patients with ITP. [Time frame: 12 weeks]
• Health-related quality of life survey of subjects(HRQoL)-1 [Time frame: 12 weeks]
• Health-related quality of life survey of subjects(HRQoL)-2 [Time frame: 12 weeks]
• Health-related quality of life survey of subjects(HRQoL)-3 [Time frame: 12 weeks]
• Health-related quality of life survey of subjects(HRQoL)-4 [Time frame: 12 weeks]

Eligibility criteria

Inclusion criteria

• Age 6-18 years old (including both ends), male and female;
• Diagnosed with primary immune thrombocytopenia (ITP);
• Patients who had previously received eltrombopag treatment and then converted to avatrombopag treatment because of ineffectiveness (platelet count < 30×10\^9/L after eltrombopag treatment, or platelet count increased less than 2 times of the basic value, or bleeding) or large platelet fluctuation or due to patient preference, economic reasons and other reasons;
• Cardiac function of the New York Society of Cardiac Function ≤ 2;
• Understand the study procedure and voluntarily sign the informed consent.

Exclusion criteria

• Secondary thrombocytopenia caused by various reasons, such as connective tissue disorders, bone marrow hematopoietic failure disease, myelodysplastic syndrome, malignancy, drugs, inherited thrombocytopenia, common variable immune deficiency, lymphoma, etc.;
• Subjects with primary disease of important organs (liver, kidney, heart, etc.), or with immune system diseases;
• Subjects who are known to be allergic to avatrombopag or any of its excipients;
• Subjects who had used rituximab within the last 3 months;
• Subjects who underwent splenectomy within the last 3 months；
• Subjects with a history of abnormal platelet aggregation that may affect the reliability of platelet count measurements；
• Any medical history or condition that the investigator deems unsuitable for participation in the study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences a — Tianjin

Identifiers

NCT: NCT06281327 · IIT2023062

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗